Background: Compounded formulations comprised of multiple medications may be useful
for some patients with refractory nausea and vomiting. The combination of lorazepam,
diphenhydramine, haloperidol, and metoclopramide (ABHR) has been used for more than a
decade in the management of nausea and vomiting, but the tolerability of this combination
in hospice patients has not been examined.
Objective: Determine the tolerability of the ABHR compound in both younger and elderly
hospice patients.
Design: Retrospective cohort study.
Setting/subjects: A total of 11,181 ABHR prescriptions dispensed to 8600 hospice patients
in the home care setting were analyzed.
Results: A total of 42 ABHR prescriptions were discontinued secondary to adverse drug reactions
(ADRs) in 39 patients. Older patients appear to be more sensitive to the effects of
ABHR, however, this trend did not achieve statistical significance when looking at extrapyramidal
symptoms (EPS) specifically in these patients. The overall incidence of EPS was
low, as only 0.1% of all prescriptions discontinued secondary to an ADR were consistent with
EPS.
Conclusions: The compound ABHR is generally well tolerated in the majority of hospice
patients. More investigation is warranted to determine the efficacy and tolerability of similar
pharmaceutical compounds used commonly in the hospice patient population.
